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WALGREEN CO.
STD89011 Sagebrush Health Services
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Covered Entity Details
Entity Name
Sagebrush Health Services
Subdivision Name
Henderson Satellite Clinic - NKDHC
Type
Sexually Transmitted Diseases
340B ID
STD89011
Entity Address
1051 Wellness Place
#140
Henderson, NV 89011
Grant Number
6 NH25PS005179-05-02
Participating Start Date
11/29/2022
Last Recertification Date
5/22/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12646
329 N. SANDHILL BLVD
MESQUITE, NV 89027-4729
Pharmacy Comments
Contract Details
Approval Date
5/5/2023
Contract Begin Date
6/16/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jami Dybik, Vice President
(843) 814-5177
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/5/2023
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